My surgery date was June 16, 2003. The insurance denied the surgery. I'm so upset and depressed. Now I have to go thru the appeal with them. Who knows how long that will take and even then if they will aprove. I'm tired of being in so much pain every day - and just plain tired from being so overweight. If anyone has any suggestions it would be appreciated.
Debbie, DO NOT GIVE UP-From what I've seen and know, persistance DOES pay off..........maybe not even after the first appeal letter but I've almost never seen them turn down someone that CONTINUES the appeal process. PLEASE PLEASE DON'T GIVE UP!!!!!!!
Debbie, I am so sorry . . . but please don't give up the fight. You know, sometimes I wonder if there is a rhyme or reason to this insurance nonsense. Both myself and an acquaintance have CIGNA, fortunately neither one of us have major co-morbidities, and we were both just approved on first try. I'm curious, are you using a CIGNA doctor? The whole thing just seems very strange. I'm sorry, I'm rambling. I do wish you luck. Linda
on 5/29/03 2:58 am
on 5/29/03 2:58 am
Debbie - Did your PCP write a letter of medical neccessity for you? If not, and you would like to provide him/her with a draft, contact me and I will give you a copy of what I did. I have Aetna, which is right up there with Cigna in denying and expected a fight; however, I was approved on the first try - you could have knocked me over with a feather. I believe it was because of the information contained in the letter. My surgery date is now set for June 16th and I live in Toms River, NJ - although I am having surgery in Staten Island.
My step-mother was denied 5 days before her surgery! She has Cigna. Evidently, Cigna instituted a new policy April 1, 2003, stating that a patient must be on a medically supervised weightloss program for 26 consecutive weeks or they will not be eligable for gastric bypass. My step-mother is devastated! There is only 1 doctor in the state of Vermont who does this surgery, and she started this whole process nearly 2 years ago. It took her 1 year to get an initial appointment, and 10 months to get a surgery date......only to get denied 5 days before her surgery!!! The salt on the wound is that my step-mother has been on a weight loss program for 3 years...but her PCP's secretary didn't state that it was for weight loss, but for diabetes(which that was not totally correct!!), and because she didn't state "weight loss" Cigna denied it! In their own letter they stated "Though this surgery is medically necessary, we are denying you." How can they find a covered procedure medically necessary, yet still NOT cover it??? Of course she is appealing, but now she has lost her surgery date. The best she can hope for is possibly November or December if her appeal is heard within the next 30 days! Something needs to be done about these insurance companies! It's ridiculous! I told my step-mother, and I will tell you...squeeky wheel gets the grease!! Do you know how many people probably get denied and give up??? That is what the insurance companies are hoping for. When you write your appeal letter copy everyone from the Governor to your Senator and congressman, to the head of the New Jersey Banking and Insurance commission. Complain to whomever will hear you. Your insurance carrier will get the point.